In the last few weeks, numerous Hawaii healthcare industry leaders have stepped forward to create deniability for themselves in the upcoming Hawaii Health Connector/Health Exchange disaster. Those who are implementing Obamacare in Hawaii are now putting themselves on the record explaining that Obamacare will mean higher insurance premiums, fewer doctors and nurses, and shuttered hospitals.

Here are their statements, accumulated in one place so that it can be clearly seen that many of those who are in charge are predicting failure:

HMSA Chief Predicts Obamacare 'Rate Shock' for Hawaii

Maui News May 9, 2013: If Hawaii consumers think health care reform will lower costs, especially in the short term, then they should brace themselves for "rate shock," said Michael Gold, president and chief executive officer of the Hawaii Medical Service Association.

His comments came Wednesday, about a week after the Hawaii state insurance commissioner approved a rate increase of 6.8 percent for HMSA....

"Across the country, people are talking about what they're calling 'rate shock,' '' Gold said. "The idea behind 'rate shock' is that it will be a shock to everybody when rates actually go up instead of coming down once health care reform is implemented....

While it's a "good thing" to extend health coverage to more people, "the money has to come from someplace," Gold said. "It's going to come from, in a sense, all of us who've been paying up until now."

Insurance rates will go up to pay for federal levies assessed on health plans, he said, "and the health plans are going to build those into their rates because they don't have any extra money."...

Last month, HMSA came under fire in a class-action lawsuit filed in U.S. District Court. The federal lawsuit alleges that HMSA has used anti-competitive practices to maintain a monopoly that has led to rapidly rising health insurance premiums for Hawaii residents....

HMSA built into its most recent rate increase the 2 percent to 4 percent it will pay for fees associated with health care reform. The revamped system arises from the federal Affordable Care Act, also known as "Obamacare," enacted in March 2010....

Although the federal government has provided $200 million to start Hawaii's online health insurance exchange, there will be costs going forward that everyone will pay, Gold said.

After the $200 million is spent establishing the exchange, "then it becomes our baby, and we're going to have to pay for it in some way," he said, adding that HMSA may need to seek another 2 percent premium increase to cover the cost.

Gold was critical of the insurance exchange, which he called a "quasi-governmental, quasi-public entity" aimed at "finding a plan for everybody, eventually."

Employers and individuals already can shop for health insurance plans in Hawaii, he pointed out.

With the insurance exchange, "we're putting another level of infrastructure or bureaucracy on top of what already exists here now," he said.

It's conceivable that multiple insurance carriers could come to Hawaii to put their offerings on the exchange for employers with fewer than 50 workers and for individuals, and they would get a broader choice of health plans, he said.

But, "that's not going to happen," Gold said. (Visualize Don Corleone) "If it happens, people in Hawaii are not going to join (the outside health plans).

"There isn't a large uninsured population in Hawaii compared with other places in the country," he said.

Nevertheless, the bill for establishing and running the exchange will come due. "Everybody is going to have to pay for the exchange, essentially," Gold said. Consumers will pay the added cost through higher health plan premiums.

Health care reform's promise of lower costs will take years to realize, he said.

"It's not in how people buy insurance," Gold said. "The real issue is how health care is delivered, and can it be delivered in a more cost-effective way that produces outcomes that lower the cost and improve the quality and everything else."

Pacific Business News May 1, 2013: Hawaii Insurance Commissioner Gordon Ito has approved a rate increase of 6.8 percent for the Hawaii Medical Service Association’s plans for small businesses, which is nearly 2 percentage points 1.8% lower than the health insurer’s original request.

HMSA had requested a rate increase of 8.6 percent for its community-rated group plans, which cover small businesses with fewer than 100 employees, or more than 118,000 Hawaii consumers. Instead, the state Department of Commerce and Consumer Affairs’ Insurance Division approved the reduced rate, which takes effect July 1, officials said Wednesday.

The plan is to continue developing a comprehensive health care plan that improves the health of the population. “We view the Affordable Care Act as a stepping stone to make that happen,” he said....

Ninety people from the public and private sector around the state, are working in eight groups to prepare a draft plan to implement the ACA in Hawai‘i. After presenting it for public response in July, a final draft will go to the governor for approval to submit with the federal application in September, he said.

The task force makes notes of where improvement is needed, he said.

Some concerns are with physician availability, and the streamlining of a system that encompasses several insurance plans, and with adjusting large business standards from 50 employees as it stands now in Hawai‘i, to the federal level of 100.

Star-Advertiser April 28, 2013: The difficulty of finding RN jobs is likely to worsen in the near term with the rollout of the federal Patient Protection and Affordable Care Act (ACA), also known as Obama­care, as providers, uncertain of how the law will affect payments for medical services, restructure and slim down their organizations.

"There's certainly a bottleneck right now as people hold on to see what's going to happen with the ACA," said Deborah Gardner, executive director of the Hawaii State Center for Nursing. "These couple of years are going to be tough. Sometimes supply and demand are not strictly in alignment, especially when you have a health care transition of a historical degree like this one. It's really going to reshape how we deliver care. "

...The job market shrunk further when the Hawaii Medical Centers in Ewa and Li­liha closed in December 2011 and January 2012, respectively.

Hawaii has 20,000 registered nurses, but only 84.6 percent are working as registered nurses, according to the Hawaii State Center for Nursing, a state agency that collects information on the nursing profession. About 650 students graduate each year from Hawaii nursing schools, including the University of Hawaii, Cha­mi­nade and Hawaii Pacific University.

New graduates often end up taking odd jobs or lower-paying positions as nurse aides or ward clerks while waiting for an RN opening. The average RN earns about $50 an hour, while a nurse aide makes about $18, according to Hawaii Pacific Health, which employs roughly 1,750 nurses.

About 150 new grads are working in non-RN roles while waiting for a position to open at Hawaii Pacific Health, parent company of Straub Clinic & Hospital, Kapiolani Medical Center for Women & Children, Pali Momi Medical Center and Wilcox Health on Kauai, said Carl Hinson, director of workforce development.

"Between 70 and 100 a year are moving into RN positions, but it's taking them one, two, three years," he said. "We still have an oversupply of new grads. We still need experienced nurses — that's where our shortage is."

Star-Advertiser April 21, 2013: ...operational changes that are coming with health care reform appears to be driving more of the existing doctors to leave their practices.

This presents a crisis for Hawaii that demands action.... Some of the scary projections, including the estimate that puts the shortage at 747 doctors this year and almost 1,500 by 2020, were presented at Saturday's 2013 Hawaii Health Workforce Summit in Waikiki.

In fact, the worry extends across the country as more of "Obamacare," formally titled the Patient Protection and Affordable Care Act, or ACA for short, is implemented in January.

Doctors already are frustrated at low reimbursement rates for Medicare patients, and many are refusing new patients — or even dropping the ones they already have — just as baby boomers are moving rapidly toward retirement.

What's accelerating the flight from practice now is concern that, under the ACA rules, doctors who haven't converted to electronic medical and prescription records will face penalties on top of that....

The transition to a different model of health care delivery is going to be a bumpy road, and a fair number of the medical establishment inevitably will veer off. (Yup. These idiots still want Obamacare--even if there are no doctors.)

Star-Advertiser April 21, 2013: There is nothing in the governor's Health Transformation Initiative that addresses the reasons doctors are refusing Medicaid patients. The managed-care policies that obstruct and deter care and associated administrative hassles for doctors are being left in place. Doctors may complain about low fees, but that is not the reason they have been fleeing Medicaid. Medicaid fees relative to commercial rates have not changed significantly in the past 20-30 years, but physician acceptance of Medicaid patients declined only after Medicaid was broken into competing private plans.

The state actually ran Medicaid much more cost-effectively than the private plans do now, but a consolidated Medicaid program could use a single third-party administrator to run the program in lieu of re-creating the administrative structures that were in place before conversion to Medicaid managed care.

Hawaii could markedly reduce Medicaid administrative costs while increasing physician participation and access to care simply by terminating our Medicaid managed-care program when the contracts expire at the end of this year, and go back to fee-for-service Medicaid. Then we could add care coordination programs funded with the State Innovation Model planning grant, including patient-centered medical homes and community care teams, and see if they help improve the cost-effectiveness of care.

Banner Quits Hawaii, HHSC Exec: “We’re not Going to Have Any Health Care”

Star-Advertiser April 20, 2013: Legislation that would enable the privatization of eight struggling public hospitals has been gutted and replaced with a task force to study once again a public-private partnership for the Hawaii Health Systems Corp.

Two-thirds of the roughly dozen "safety net" facilities on Maui, Lanai and Hawaii island have been exploring a deal with Phoenix nonprofit Banner Health to acquire parts of HHSC to improve the quality of medical services on the neighbor islands.

A 2009 legislative study recommended a public-private partnership be forged within two to three years "in light of the financial status of both HHSC and the state." The public hospital system posted an operating loss of $143.5 million last year, while the state contributed $73.4 million in general fund subsidies.

"HHSC has been studied over and over again," said Wesley Lo, Maui Memorial Medical Center chief executive officer. "We don't even want a task force because what's the sense of studying something when you already have one by experts? Health care is in a crisis right now: Reimbursements are going down, we've got aging facilities, doctors are leaving. If we don't change the way we do business, we're not going to have any health care."….

Banner Executive Vice President Ron Bunnell said without legislation allowing the mainland operator to take over multiple facilities, there is no vehicle for a deal to move forward.

"It's not going to pass this year. The question is, Will it be able to pass next year?" he said. "That's too far in the future for me to make a commitment as to whether we would be in a position to operate those hospitals."

Star-Advertiser April 19, 2013: More Hawaii doctors have left their practices over the past year and likely will continue to do so just as the first major piece of federal health reforms rolls out.

More than 60 doctors left the market within a year, shrinking the workforce by 2 percent after two years of growth, according to preliminary data from the Hawaii/Pacific Basin Area Health Education Center.

The latest estimate places the shortage at 747 doctors this year and nearly 1,500 by 2020. A year ago the shortage was estimated at around 600, based on statewide supply and demand figures. The data will be presented at the 2013 Hawaii Health Workforce Summit on Saturday at Hilton Hawaiian Village.

"It alarms me because in 2020 we could have 40 percent fewer physicians than we need," said center Director Kelley Withy. "There are many changes coming to medicine that some physicians might not like. They will in time help, but if someone is close to retirement, they might not want to invest in the necessary changes such as electronic health records."

Under the federal Patient Protection and Affordable Care Act, the most significant changes of which take effect in January, doctors will face penalties, including reductions in already low Medicare reimbursements, if they do not use electronic medical records and electronic prescribing in their practices.

Penalties start at a 1 percent Medicare payment reduction to as much as 5 percent over the next few years, she said.

Withy, a supporter of health reform, also known as Obama­care, recently stopped practicing medicine after working as a family physician for more than 20 years.

"In part it's the hassles of practicing medicine in the current times," she said. "There's more paperwork, electronic requirements and changing in the rules. There's more audits now. Things are always changing, and it's so hard to keep up with." (Brainwashed to the point where she can describe the failure of the system while still supporting it. Wow. Just wow.)

Zane Benefits April 16, 2013: Hawaii has not publically released the formal role, and compensation structure, for agents and brokers selling policies on the Hawai'i Health Connector. Based on public governance meeting notes (March 14, 2013), the Exchange is discussing a model where producers (not acting as official Navigators) would receive a type of compensation, fee or stipend. The Exchange recognizes the importance of agents and brokers in the Exchange, however at the time of writing details have not been decided or released confirming the fee structure and who would pay the fees (exchange vs. carriers).

Richard Borreca, Star-Advertiser April 9, 2013: ….For instance, just the cost of restoring the public worker pay cuts taken during the recession adds $78 million a year to the budget….

Perhaps the most serious hand-wringing comes from the Rep. Sylvia Luke's Finance Committee report, which notes that 23 percent of Hawaii residents are on some version of the joint federal-state Medicaid program.

The state Health Department is asking for increases of $207 million for the next two years for the health care payments.

The total state-federal costs are $4 billion, with the state's general fund share to be $1.8 billion for two years.

"Hawaii offers a Medicaid benefits package that is among the nation's most generous," Luke's report says.

She warns that Medicaid costs are expected to grow and that "without an accompanying effort in managing costs it will be unsustainable."….

"Your committee finds that the Department is still mired in bureaucratic inertia," he reports, adding that, "Your committee has grave concerns with the Department's ability to monitor and track its resources."

For instance, Ige says he asked for a report on all temporary positions established by the DOE and learned that the DOE has more than 1,000, and that they go on year after year, even though state law says "they shall not exceed a one-year term."…

Luke complained about the state's Health Department, noting that it seems to be in the throes of an undefined reorganization.

"The department's five-year financial plan … lacked an explanation of how the department's movement of funds and positions justifies its extensive, multiple, and prolonged internal reorganization initiative and financial plan," the report stated.

Luke warned that she did not want to toss state money for programs "that were eliminated due to insufficient oversight, inefficient administration, ineffective outcomes and most importantly duplicative services …"

Star-Advertiser April 9, 2013: The Hawaii Medical Service Association has asked to increase health insurance premiums on small businesses July 1 by an average 8.5 percent, its largest rate increase in four years.

HMSA, the state's largest health insurer, said Monday it needs the increase in part due to costs related to the new national health care reform law.

"Costs are increasing this year, partially due to health care reform," HMSA spokes­woman Elisa Yadao said in an email. Assessments and taxes related to health care reform account for approximately 23 percent of the rate request, she said.

The rate increase would apply to approximately 8,800 small businesses with fewer than 100 employees, Yadao said. HMSA said there are about 81,000 individuals affected. The state Insurance Division put that number at 118,000….

The 8.5 percent increase is for members in HMSA's preferred provider plan, which is the most common plan. HMSA is asking for a 9.1 percent increase for small-business employees on its health maintenance organization plan, HPH Plus….

The nonprofit Connector announced Monday it had won $128 million in federal funds to develop the exchange but hasn't determined how it will pay for its operations after 2014. Some states are assessing fees on insurance carriers.

As the health care reform law is implemented over the next few years, consumers and businesses can expect to see higher rate increases, said Gary Lee, a Hono­lulu-based principal with Mercer, a New York human resources and benefit plan consultant.